Original Research Article
Year: 2019 | Month: January | Volume: 9 | Issue: 1 | Pages: 190-199
Management of Typhoid Fever at a University Hospital in Sub-Saharan Africa: Challenges and Prospects
Godwin Terver Jombo1, Emmanuel Msugh Mbaawuaga2, Usman Ahmed1, Paul Ogor Abba3, James Orduen Tsor4
1Department of Medical Microbiology and Parasitology, College of Health Sciences, Benue State University Makurdi, Nigeria
2Department of Biological Science, Faculty of Science, Benue State University, Makurdi Nigeria
3Department of Medical Microbiology, Benue State University Teaching Hospital, Makurdi, Nigeria
4Department of Physics, Faculty of Science, Benue State University, Makurdi Nigeria.
Corresponding Author: Godwin Terver Jombo
Correct diagnosis of typhoid fever using clinical signs and symptoms alone is usually difficult in most Nigerian health settings especially where laboratories are also ill equipped. Tying clinical features of typhoid fever with laboratory findings becomes necessary for quick reference by health facilities with poor laboratory settings. This study was therefore set up to ascertain the association between clinical presentations of suspected typhoid fever patients and probable corresponding laboratory diagnosis of typhoid fever among them. Three hundred and eighty-nine patients with clinical diagnosis of typhoid fever attending Benue State University Teaching Hospital (BSUTH) Makurdi between November 2016 and April 2017 were consecutively recruited into the study. Structured close-ended questionnaires were administered to the respondents on their socio-demographic parameters, and on symptoms and signs of typhoid fever. Blood and stool samples were collected from each subject where Widal test was carried out on the blood samples and stool samples were cultured. Results were analysed using Excel and Epi-Info. Of the 389 subjects 35.0% (136/389) had titres ≥80 while 65.0% (253/389) had titres ≤40. Among the males 39.5% (94/238) had Salmonella antibody agglutination titres ≥80 while 27.8% (42/151) of the females had titres of ≥80. There was significant gender difference (P< 0.05) with male preponderance and a mildly strong age correlation (R= 0.44). The most prevalent clinical features recorded were Fever 77.9% (n=303), Headache 63.0% (n=245), Weakness 50.9% (n=198) and Abdominal pain 24.7% (n=96). Stool cultures yielded four species of Salmonella enterica serovar typhi and one Salmonella enterica serovar paratyphi with a weak positive predictive value of 13.7%. The most active antimicrobials were ofloxacin, amoxiclav and ceftriaxone (100% active each) while co-trimoxazole, amoxicillin, erythromycin, and tetracycline were 100% resistant. Widal agglutination test should not be considered first line test for typhoid fever and a more reliable serological test is needed. It may however be used in conjunction with prevailing clinical features and culture procedures while ofloxacin, amoxiclav and ceftriaxone should be considered drugs of choice. We should also sustain sensitivity testing against the highly resistant drugs as part of monitoring and surveillance.
Key words: Agglutination test, Diagnosis, Salmonella, Typhoid fever